WHAT HAPPENS WHEN I APPLY?

When you file an application for Supplemental Security Income (SSI) benefits based on disability or blindness, we will first decide whether you meet the income and resource criteria and other eligibility
requirements. If you do, we will ask you for the:

dates, places, and types of work you have done in the 15 years before you became unable to work because of your illnesses, injuries, or conditions, including your daily duties for the type of work you did and why your employment ended;

information about your physical or mental impairment(s);

names, addresses, and telephone numbers of doctors, hospitals and any other medical sources you have seen;

dates of treatment and the kinds of treatment you have received from your doctors, hospitals and other medical sources;

names of each prescription and non–prescription medicine that you take and the doctor who prescribed it;

the kinds of medical tests you have had, when and where they were done, and who sent you for them; and

for a disabled child, the name, address, and telephone number of the child's school and teacher and a third party to assist with the claim.

IT IS VERY IMPORTANT TO GIVE US COMPLETE INFORMATION.

As part of the disability or blindness determination, Social Security also looks at any work you are doing. Generally, if you are working and earning more than $1,130 per month (effective January 2016) we will not find you disabled. We call this substantial gainful activity. We apply a higher SGA if you are blind.

The local Social Security office personnel do not make the disability determination. The local Social Security office sends the claim to a State agency that we call the Disability Determination Services (DDS). The DDS decides whether or not you are disabled according to the SSA definition of disability.

We, or the DDS, may ask you to fill out forms about your disability or blindness. If you need help, a Social Security or DDS employee will help you. If we mail the forms to you, you can also ask someone to help you.

OBTAINING EVIDENCE ABOUT YOUR IMPAIRMENT(S) AND FUNCTIONING

The DDS does not examine you and they usually do not meet with you. They may contact you for additional information. While they will not base their decision solely on your statements about yourself, (for example, the fact that you are enrolled in special education classes), that kind of information is very important and useful.

If the DDS cannot get enough information from your doctors and other people to decide if you are disabled, they will arrange and pay for an examination or testing by a qualified
medical professional (who may be your own physician, psychologist, optometrist, or speech/language pathologist or other health care provider).

We use the term substantial gainful activity (SGA) to describe a level of work activity and earnings that is both substantial and gainful. SGA involves performance of significant physical or mental activities, or a combination of both. For your work activity to be substantial you do not need to work full time. Work activity performed on a part-time basis may also be SGA. If your impairment is anything other than blindness, earnings averaging over $1,130 a month (for the year 2016) generally demonstrate SGA.

Gainful work activity is:

work performed for pay or profit, or

work of a nature generally performed for pay or profit; or

work intended for profit, whether or not a profit is realized.

For SSI purposes, the SGA provision in initial eligibility cases does not apply to blind individuals.

HOW LONG DOES THE DECISION TAKE?

The timeframe can vary widely, but the decision usually takes about 3 to 4 months from the date of application.

If you have a Compassionate Allowances (CAL) condition, your case may be fast-tracked and decided sooner. The CAL process is for applicants whose medical conditions are so severe that their conditions will almost always meet Social Security’s disability standards. Individuals with a CAL condition apply for benefits using the standard SSA process for filing claims for SSI. SSA will expedite the applications of those with a CAL condition. For more information about CAL, visit our website at: https://www.ssa.gov/compassionateallowances/.

Sometimes, we can make a "presumptive" disability or blindness determination and start paying you while waiting for the DDS to make the final determination.
See expedited payments.

After helping you complete your application, the Social Security office will review it to make sure that you meet the basic non-medical requirements for disability or blindness benefits. Then the Social Security office will send your application to the DDS office in your State. The DDS will decide whether you are disabled or blind under the Social Security law.

The DDS will consider all the facts in your case. They will consider what your doctors or other sources have said about your impairment(s), when it began, how it limits your activities, what the medical tests have shown, and what treatment you have received. They will use medical evidence from your doctors and from hospitals, clinics, or institutions where you have been treated, and all the other information they have about your condition.

The DDS looks at the information you have given us. They also review your medical records, information about how you are functioning, and, if applicable, your work history, and then decides if you are disabled or blind for SSI purposes.

If they cannot make a determination based on the information they have, the DDS will schedule a special medical examination or test for you and will pay for this examination or test. They may pay for your travel expenses to this examination or test. It is important that you go to the special medical examination or test if one is scheduled. If you do not keep the appointment, the DDS could deny your claim.

In deciding if you are disabled, the DDS team uses a process called the sequential evaluation process.

WHAT IS THE SEQUENTIAL EVALUATION PROCESS?

If you appear to meet all the non–medical eligibility requirements (income, resources, residency, citizenship, etc.), we use a step–by–step process to determine if you are disabled. These steps are called the sequential evaluation process. The following sections describe how we use the sequential evaluation for adults and children.

SEQUENTIAL EVALUATION FOR INDIVIDUALS AGE 18 OR OLDER

STEP 1: ARE YOU WORKING?

If you are performing substantial gainful activity (SGA), we cannot consider you disabled, and the process ends here. We make this decision in your local Social Security office.

We generally consider earnings over $1,130 per month (effective January 2016) to be SGA.

If you are not performing SGA, we will send your case to the DDS for a determination concerning your impairment(s). We refer to the DDS as “we” in the following sections because Social Security uses the DDS to decide whether you are disabled according to Social Security’s definition of disability.

STEP 2: DO YOU HAVE A SEVERE IMPAIRMENT?

If you are not performing SGA, we then decide if your medically determinable physical or mental impairment or combination of impairment is "severe". An impairment is considered severe if it significantly limits your physical or mental ability to do basic work activities.

responding appropriately to supervision, co–workers and usual work situations; and

dealing with changes.

If your impairment (s) is not severe, we will find that you are not disabled. If your impairment (s) is severe, we will go to the next step.

STEP 3: DO YOU HAVE AN IMPAIRMENT THAT MEETS OR MEDICALLY EQUALS A SOCIAL SECURITY "LISTING"?

If your impairment(s) is severe, then we decide if it meets or medically equals a listed impairment(s) in our Listing of Impairments (the Listings).

You are disabled if you have an impairment that:

meets the criteria of one of the impairments in the listings; or

medically equals the criteria of one of the listings.

We determine if your impairment(s) “meets” one of the listings by comparing it to the specific requirements in the listings. It is not enough to have a diagnosis that is named in the listings. We determine if your impairment(s) medically equals one of the listings if it is at least equal in severity to any listed impairment. If your impairment(s) meets or medically equals the requirements of a listing and meets the 12-month duration requirement, we will find you disabledand the process ends here.

If your impairment(s) is severe, but does not meet or medically equal a listing, we can still find you disabled at a later step in the process. We decide the most you are physically and mentally able to do, despite the limitations resulting from your impairments. We call this a "Residual Functional Capacity" (RFC) assessment.

STEP 4: ARE YOU ABLE TO DO YOUR PAST WORK?

We next consider whether, given your RFC, you are physically and mentally able to do any job that you did in the past (generally the last 15 years). At step four, we do not consider whether you can get a particular job, but whether you can do a particular job. If, you are able to do work you did in the past, we will find you are not disabled. If you cannot do your past work, we consider the fifth step of the sequential evaluation process.

STEP 5: CAN YOU DO ANY OTHER KIND OF WORK?

At step five, we consider your RFC limitations, vocational factors such as age, education and work experience, and work existing in the national economy. Generally, your ability to do other work is greater if you are younger, have more education, or have learned transferrable skills in previous work. If you cannot perform other work, we will find you disabled.

STEP 1: IS THE CHILD WORKING?

If a child is working and performing SGA, we cannot consider the child disabled, and the sequential evaluation process ends here. Your local Social Security office determines whether a child is performing SGA. We define SGA for children in the same way that we define it for adults. We define “SGA” in the section WHAT IS SUBSTANTIAL GAINFUL ACTIVITY.

STEP 2: DOES THE CHILD HAVE A SEVERE IMPAIRMENT?

If the child is not performing SGA, we will determine if the child has a medically determinable physical or mental impairment or combination of impairments (hereafter referred to as impairment(s)) and whether it is severe. An impairment(s) is not severe if it is only a slight abnormality or a combination of slight abnormalities that causes no more than minimal functional limitations. If the child does not have a medically determinable impairment(s), or the child has an medically determinable impairment(s) but it is not severe, we will find that the child is not disabled. If the child has a severe medically determinable impairment(s), we will go to the next step.

If the child has a severe impairment(s), we determine if the impairment(s) meets or ismedically equivalent to the criteria of the listing. The listing of Impairments (the Listing) covers the major body systems and includes descriptions of common physical and mental impairments (such as cerebral palsy, intellectual disability, and asthma) along with specific medical severity criteria.

A child is disabled if he or she has an impairment that:

meets the criteria of one of the impairments in the listings; or

medically equals the criteria of one of the listings; or

functionally equals the listings.

We determine if a child’s impairment(s) “meets” one of the listings by comparing it to the specific requirements in the listings. It is not enough to have a diagnosis that is named in the listings. A child’s impairment medically equals one of the listings if it is at least equal in severity to any listed impairment. If a child’s impairment(s) meets or medically equals the criteria of a listing and meets the duration requirement, we will find the child disabled.

If a child’s impairment(s) is severe but does not meet or medically equal a listing, we determine whether the impairment(s) “functionally equals” the listings. This means that we evaluate the effects of the impairment(s) on the child’s ability to function at home, at school, and in the community.

We will consider questions such as:

how does the child function compared to children the same age who do not have an impairment? That is, what is the child able to do, not able to do, or is limited or restricted in doing?

what type and amount of help does the child need to complete age-appropriate activities?

what are the effects of treatment on the child’s day-to-day functioning?

Once we have a clear picture of a child’s functioning in all activities and settings we evaluate the child’s functioning in six domains. The domains are broad areas of functioning intended to capture all of what a child can or cannot do. They are:

acquiring and using information;

attending and completing tasks;

interacting and relating with others;

moving about and manipulating objects;

caring for yourself; and

maintaining health and physical well-being.

If a child’s impairment(s) results in “marked” limitations in two of these domains of functioning, or an “extreme” limitation in one domain, then his or her impairment(s) functionally equals the listings.

We define "marked" and "extreme" limitations in several ways in our rules. The most general definition of a "marked" limitation in a domain is when a child's impairment(s) interferes seriously with the child's ability to independently initiate, sustain, or complete activities. An "extreme" limitation in a domain is when a child's impairment(s) interferes very seriously with these abilities.

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THIS INFORMATION IS GENERAL. FOR MORE INFORMATION, CALL 1-800-772-1213 (TTY 1-800-325-0778), OR CONTACT YOUR LOCAL SOCIAL SECURITY OFFICE.

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